Tag Archives: Substance Abuse & Addictions

Substance Abuse & Addictions

Stepping into recovery

By James Rose June 13, 2018

After many years of working as an accountant, I decided to enter counseling as a profession in my “retirement” years. After four years in graduate school, including two years of clinical work at an addictions recovery center, I began my new professional career this past January. Here is how it began.

 

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It was my third day as the evening counselor at Ashley Addiction Services. A clinical aide called me and said, “We have a patient here who wants to leave now. He’s calling his girlfriend to get a ride, and he is looking for someone to punch so he can get kicked out. Would you come down?”

The patient was a young man I had met during my training period the prior week. “You look stressed,” I said.

“Of course I’m stressed!” he screamed back.

I coaxed him out of the clinical aide’s office to a quiet place where we could talk. He told me he was on the withdrawal drug Suboxone. He wanted to go out and get high, then quickly get enrolled in another facility so he wouldn’t disappoint his mother.

“Your mother’s opinion is important to you,” I said.

“Of course,” he said.

“What about your dad?” I asked.

“He’s dead,” he told me.

I asked him to tell me more. He had been using for seven years. This was his fourth stay in a recovery facility.

“What happened seven years ago?” I asked.

“Nothing,” he said.

“When did your dad die?” I asked, following a hunch that there might be a link.

“Five years ago,” he said.

No link, I thought.

I had been working in addictions recovery for two and a half years at that point. I spent most of my life as an accountant, working in grants administration at various universities. At age 58, I had a near-fatal heart attack, and during my recovery, I knew that I had to change course in my life. Counseling had always fascinated me, and I had been in and out of therapy myself for about seven years. I made the decision six months after the heart attack to make a major course change in my life and study counseling. I enrolled in the pastoral counseling program at Loyola University Maryland, the same school where I had earned a Master of Business Administration 26 years earlier.

As part of my counselor training, I had worked as an addictions counselor at the Westminster Rescue Mission. I remembered a story about another patient I had worked with there who reminded me of my current patient. I shared that story with my current patient, explaining that my former patient’s parents divorced when he was 5. His dad lived only a few blocks away after the divorce, but he rarely saw his dad. Sometimes his father would tell him he would take him fishing on a Saturday morning, so this young boy would get up early, get dressed, assemble his gear and wait all day at the living room window for his dad to come. His father never came.

My former patient started shooting heroin when he was 18 and continued to do so for the next 24 years. After working with this patient for a year, he said to me, “Until we talked, I never understood the connection between what my father did and my addiction.”

Something in this story seemed to resonate with my current patient. So I asked him again, “What happened seven years ago?”

“That was the year my dad got sick,” he said. “He got diabetes and had to have his foot amputated. He was my rock.”

And then it hit him: the link between his dad’s sickness and death, and his own addictive behavior. He jumped out of his chair, threw his arms around me and shouted, “You just saved my life!”

I breathed a sigh of relief. It was a heady moment for me. We both knew an important bridge had been crossed. We talked a little while longer, then went for a quiet walk outside.

 

An epidemic of loneliness

People talk of the tragedy of the opioid epidemic. And the tragedy is painfully real. One of my patients lost two friends during his first weekend in recovery, and he believed that if he had not come in for help, he too would be dead. Another patient found his best friend dead from the dope he had shared with him. A third patient stood before the entire patient community and told us that he had lost 42 friends to overdoses in one year, and he knew that if he did not come in for help, he might well be next.

And yet from my perspective of working with people in addiction, the opioid epidemic masks a deeper epidemic. The epidemic I see every day is an epidemic of loneliness.

It is so ironic. We have never been more connected. We have cell phones, email and FaceTime. We can meet anyone, anytime, anywhere. The world I live in today reminds me of the futuristic world I saw pictured in science fiction comic books when I was a kid. And yet, rather than being more connected, we seem more distant from each other than ever before.

I believe that we all need a deep sense of connection with other people in our lives. Emotional connection is an essential part of being human.

People in recovery are in a state of inner conflict. They simultaneously want to recover and stop abusing drugs and alcohol, while at the same time they have cravings to continue to use. When they stop using, once they get through the painful physical symptoms of detoxifying, the painful emotions that led them to use in the first place tend to rise to the surface. Often, there is a painful event or painful circumstance in their lives that caused them to use in the first place.

Substance abuse is often a coping strategy, a way of easing pain, and very often it is some painful event that triggered their addiction. Substance abuse serves a function in their lives; it reduces their pain enough to enable them to cope and carry on with their lives. In that way, it is similar to taking a pill to get rid of a headache. Of course, the circumstances are far more drastic.

I asked one user why he used heroin, and he said it was better than committing suicide. It was hard for me to argue with his logic. From his perspective, heroin use had the positive aspect of keeping him alive, of keeping him from killing himself by his own hand. That is part of the reason that it is so hard for people to give up their addiction. It serves the positive function in their lives of keeping them alive, allowing them to continue to function, in spite of their pain. It numbs out their pain, however temporarily.

Unfortunately, in numbing out their pain, it numbs out all of their other emotions as well. This is why it is nearly impossible to have a meaningful relationship with someone who is addicted to a substance. Meaningful relationships require an emotional connection. How can one have a meaningful connection with someone whose emotions are chronically numbed out?

 

Breaking the cycle

The damage of addiction spreads out like the ripples in a pond, far beyond the individual who is addicted, to affect all the other people in that individual’s life — friends, family members, co-workers. Children of parents who are addicted grow up with parents who are emotionally unavailable. These children’s lives are shaped by the experience of emotional unavailability, and so the cycle continues.

Breaking that cycle of emotional absence is at the heart of the work I do. When patients stop using, the emotional pain that led them to use in the first place reemerges, and they often are as unequipped to deal with that pain in the present as they were in the past. As their counselor, I help patients to identify past trauma and try to find a new perspective through which to see it.

One way of looking at emotions is to think of them as predictions of what is about to come. If you enter a house filled with the aroma of freshly baked chocolate cookies, you might find your mouth starting to salivate and your stomach starting to rumble — physical signs that your body is preparing for you to eat something yummy. A sudden scream in the night might make your body straighten, your muscles tense, your eyes widen and your ears perk up — all signs that your body has gone into a high state of alert for possible danger, usually accompanied by a sharp rush of adrenalin to be ready for fight or flight. Again, these are the physical signs of anticipation of and preparation for predicted danger.

Emotional pain evokes different bodily reactions. We may feel a loss of appetite, a heaviness of heart and a wish to isolate. The triggers for emotional pain may be less obvious to a person than is the smell of cookies or a scream in the night, but they are certainly quite real to the person experiencing them. And the pain can be overwhelming.

This is where substance abuse comes into play. Often, emotional pain comes about when a person has lost someone with whom they had an important emotional connection in their life, and that emotional connection has been broken. If a parent has died or moved away, a loved one has betrayed you or a traumatic event such as a rape or murder has occurred, there is no way to undo the event. The pain of such events can be overwhelming.

Drink or drugs can provide a means of easing the pain enough that the suffering person can get on with their lives, but they cannot undo the event. Many people find solace over time and find ways to cope with the pain without resorting to drink or drugs; however, many do not. Because drugs numb the pain without addressing the loss, a person remains stuck within the loss, and so the need for the drug endures.

The damaging paradox of a person who uses drugs to deal with the loss of emotional connection is that drugs eliminate the possibility of creating new emotional connections, which are the very thing the person needs to heal. Drugs numb out all emotions — both the painful and the joyful ones — and without the ability to feel the full range of emotions, any new, real emotional connections are impossible to create.

 

Searching for ‘meaning’

Being with a person in the initial stages of recovery from substance abuse is an awesome experience. As a counselor, I face them in that moment of transition in their life. I know I cannot fix or heal anybody. The thing I can do is to be present with them, offering what guidance and presence I can as I try to help them find healing within themselves.

Often, that is a matter of helping them name and identify those hard emotions that arise within them — the ones that led to substance use in the first place. Once the emotions are identified, then we look for the event or the circumstance in their life that brought that emotion into play. This is the moment when the hard stories come out, the stories of heartache and loss. And then it is a matter of looking at the meaning those stories have had in their lives.

It is the meaning we place on our stories that give them their emotional charge. A child whose parents divorced and whose father moved away might, as a child, believe in some unnamed way that they are worthless. After all, dad delivered the message, in the most obvious way possible, that they were not worth sticking around for. I have known many people struggling with addiction who had just that circumstance in their lives, and that sense of worthlessness was at the root of their addiction.

In this work, we can look at stories like that and change the meaning. The meaning might be that dad was a troubled man. It might be that dad and mom had a bad marriage and their breakup was necessary. It might be that dad had to go away on a job or for military service. By reframing the story, we can change the meaning, and when we change the meaning, the emotions that accompanied that story can change.

This was the case for the young man whose story I shared at the beginning of this article. For him, the meaning of his dad’s sickness and death was that he was losing his rock, and there would be no one there to give him guidance. His story changed to dad was sick and died through no fault of his own, nor by his father’s choice, and now he would have to find his own guidance. In changing the meaning of his story, his emotions changed, and his need to numb out his painful emotions with drugs gradually evaporated.

 

Being present

So, at the heart of my work is the aim of being present with another person so that they can learn to be emotionally present themselves. One of my favorite outcomes was when a patient told me about his 17-year-old daughter. She was the rock of their family, a straight-A student who was always reliable and dependable, emotionally calm and stable.

She came to visit her father a few weeks after he had entered recovery. He told me he could not believe what had happened. His strong, calm and rational daughter had broken down in tears in front of him. I said, “She was emotionally present with you.” After a moment, I asked, “Do you understand why?”

He looked baffled and said, “No.”

I said, “For the first time since she was a little girl, she could sense that you were emotionally present for her, no longer drunk or high, but really right there with her. She felt it, and so she, for the first time in years, was able to be emotionally present with you. That is why she cried.”

My final meeting with the young man whose father had died of diabetes was the night before he completed the program. He told me that he was planning to move back home where he could help his mother. He expected he would be able to go back to work at his job in a restaurant, and he planned to attend school in the fall. I asked what he would study, and he said he was interested in psychology. He said he was thinking of becoming a counselor, which would further motivate him to stay on his path of recovery.

I saw him again the night he finished the program. I was thinking of the years I had spent in grad school — the books I had read, the papers I had written, the checks I wrote and all the time I had invested. And in a moment, it was all worthwhile when he threw his arms around me and said, “Thank you.”

 

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James Rose, a national certified counselor and graduate professional counselor, is a recent graduate of Loyola University Maryland and works in addictions treatment at Ashley Addiction Services. Contact him at jrrose@loyola.edu.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The opioid crisis and a wounded counselor’s heart

By Antoinette D’Angelo (pseudonym) May 14, 2018

[Editor’s note: Because of the personal nature of the narrative, the author is using a pseudonym.]

 

“Welcome to the club!” This greeting, typically extended to new members, often implies certain advantages, discounts and perks. However, the club my husband and I unwittingly have joined is based on an experience I would not wish on my worst enemy.

We received “the phone call” — the one every parent dreads in their wildest nightmares — at 2:30 in the morning in mid-February. It was the police station calling to tell us that our son had overdosed. He was alive, barely, but they had found him just in time.

A tumult of thoughts raced through my mind. Our son lives 2,600 miles away. Could it be a mistake? Were they sure it was our son? He wasn’t supposed to be in that city. What is happening?

As I write this, I know similar words must have been said or written a million times over by so many other heartbroken parents. In truth, there is nothing new to read here. Yet, it is my son I am writing about, my “kid” (now in his 30s). It is my same son whom I desperately worried may not live when I went into labor at six months gestation. It is my child whom the OB-GYN gave only a 10 percent chance to make it. It is my child who did make it, who went on to do great in school, who had tons of friends, who graduated from college, who got married and had a wonderful job. It is my kid who loved cutting down Christmas trees when he was little, swam like a fish and played soccer until his feet ached. It is my child who loved our annual summer trips all across the country to see major attractions and visit dozens of national parks. And it is my son whom the police were now telling us had almost died of an opioid overdose.

I write this story partly for the cathartic release it provides. Our family has cried more tears over the past few months than we could have previously imagined possible. Perhaps more important though is this: The ultimate irony of this situation is that I am a licensed mental health counselor, a licensed addiction counselor and a master addiction counselor. I am an assistant professor of counselor education and teach courses in addiction and treatment. I “know” so very much — maybe even too much on paper — about this disease of addiction, while simultaneously finding that I know so very little.

 

A quest for treatment

A few hours later, we raced to the airport, my husband catching the first available flight to the East Coast. We decided that once my husband got more information, I would fly out. Unfortunately, his plane was delayed, he missed his connecting flight and he ended up arriving after midnight. With no “new” news about our son, the hours ticked by excruciatingly slow.

The next morning, my husband went to see our son in jail — the words still seem incredulously stark written here. They brought our son out in a wheelchair. He was retching violently, trembling uncontrollably and could barely speak. My dear, sweet, gentle husband wept because he thought our son, who was in full-blown detox, was going to die. My husband and son could talk with each other only through a television screen. After 10 minutes, they took our son away.

I called the jail shortly thereafter and pleaded to find out what was happening. The response was that they weren’t allowed to tell me. Many hours later, I was routed to an “angel” sergeant who explained the jail’s “detox protocol” — they give the inmates Tylenol and a pill for nausea, but the inmates throw that up immediately.

Our son was in sheer agony, and we had never felt so utterly helpless in our entire lives. We could not even get a message to him. The whole experience shook us to our cores, and we felt nearly incapacitated by immobilizing grief.

My husband had his “one allotted visit” for the week, which was on Saturday, meaning that the next visit couldn’t be until Monday. We were distraught with worry about our son’s condition but weren’t allowed any additional information. We contacted an attorney in the area whom we had worked with previously years prior. Blessedly, he took on our son’s case but was likewise unable to find out anything over the weekend — and Monday was a holiday. Our agony continued, piercing our souls.

Tuesday was the bond hearing. Our son had been charged with two felonies and two misdemeanors. Our attorney spoke on our behalf. Amazingly, our son was released from jail in our recognizance, as long as he agreed to go directly into treatment.

The next several days were a blur-filled nightmare that involved navigating the quagmire of insurance situations. We found that because our son was “five days sober,” no detox unit would take him, reasoning that he was not in quite desperate enough straits at that point. No residential treatment center would take him; he didn’t qualify for Affordable Care Act insurance because he had lost his job. He couldn’t get on Medicaid because his physical address was listed a state away. We couldn’t get the best insurance money can purchase because he had a pre-existing condition. Our son was still in a very fragile state, with double vision, horrible stomach pains, crawling skin sensations, major sleep deprivation and continuous hot/cold sweats. He needed help — fast.

With no other viable options, our attorney managed to get an emergency stipulation granting my husband permission to drive our son the 2,600 miles across country to where we live. Meanwhile, I had stayed at our home, spending countless hours investigating insurance options and trying to find a residential treatment center for our son. My husband drove as he never had in his life, making the trip in three and a half days. They arrived in the middle of the night, our son a mere shell of the vibrant, funny, creative, loving soul that he once was.

We signed our son up for Medicaid in our state, which featured a 45-day backlog. We could request emergency consideration, with the possibility of them meeting us within 48 hours, but there was no guarantee. Our son would have to be assessed, and then there was the issue of actually finding him a bed at a residential treatment facility.

I must have contacted at least 25 treatment centers; none would take Medicaid. So there our son languished. We watched him slipping away from us as he struggled with his new sobriety and no treatment. If our son had been suffering from any other “acceptable disease,” waiting to obtain treatment would have been deemed unconscionable and cruel. From my view, it is beyond words that we ask those who suffer to simply bear their pain and deal with it.

I emboldened myself to share the situation with some trusted co-workers. The disease of addiction is still fraught with stigma, but I was so beyond that now, knowing that if we didn’t find something soon, the agony our son was experiencing would lead him to the streets. Human beings can withstand only so much pain. He was attending 12-step meetings as best he could but was so weak, it was hard for him to focus. He was more than ready for treatment and begged us to help him find something. He was simply too ill to do this on his own.

Through the grace of a co-worker, I was able to contact a treatment center that a relative of hers had attended with great success. I called, and we made an appointment the next day. The center took only private insurance, but we had already explored every other possibility. There were no other viable alternatives. It caused us to ponder, what does a person do who has no access to health care? (And, thus, all the overdose headlines!) We brought our son in for an intake assessment, and three hours later, he was in detox treatment; the timetable was for 35 days.

 

 

An equal-opportunity disease

Our story is merely a reflection of the countless individuals now suffering from our nation’s opioid crisis. Tragically, a huge percentage of those addicted are not so lucky as our son has been to have survived. Our son has an unfathomable journey ahead of him to maintain his sobriety. The shattering statistics confirm that only about 10 percent of individuals who are addicted find treatment — perhaps half of them will remain sober.

Our son’s addiction to opioids started as many others have. He had a back injury at work a few years ago, and his doctor prescribed OxyContin. Our son found some relief from the back pain but, more insidiously, found that it also helped with his longtime struggle with depression. Alas, he was a sitting duck. When the pills were gone, he tried to get more from the doctor, to no avail. He finally asked a friend, who led him to someone who had a few, and the rest is history.

On the streets today, one pill of OxyContin can cost as much as $60; a bag of heroin costs $5. There is no mystery why so many turn to heroin — not to get high but rather to relieve the impossible, all-consuming withdrawal. My son told us he tried countless times to overcome “the beast” on his own. The longest he made it was two and a half days — two and a half days of wretched, skin-crawling, vomiting, horrible agony. And we wonder why so many people are addicted. We treat people like criminals just for self-medicating their pain. We seldom think of them as even being human anymore, deserving of immense care.

As I tell my counseling students all the time, addiction is an equal-opportunity disease. I’m not a person in recovery, but I have attended dozens of 12-step, self-help meetings through the years. I worked as the program director of an outpatient substance abuse clinic for 10 years, often accompanying colleagues to open meetings so that I could honestly recommend them to my clients, know what they were all about and for the knowledge of “keeping it real” (that last one is crucial to me as a counselor and an educator.)

When I teach addiction courses, I ask my students to attend at least two open 12-step meetings if they are not seeking their own recovery but are there to learn, or two closed meetings if they are there to help themselves. They come back to class and share their experiences, which are often incredibly humbling to hear. They include tales of feeling embarrassed, finding it hard to enter the buildings, driving around several times looking for the courage to go in and acquiring sincere admiration and respect for those in recovery who have survived and share their journeys with others. The textbooks we have are tremendous, but nothing replaces the personal epiphany one can attain by witnessing these 12-step meetings. Many students have shared the sentiment, “There but for the grace of God …”

 

Holding on to hope

My irrational side tells me to beat myself up. I have been blessed with all this incredible knowledge and insight as a counselor and still did not know what my son was going through? I have refused to do so, however, not only because I realize that now is not the time for recriminations, but because I fully comprehend that addiction is a baffling and cunning disease.

It all makes sense now, of course — the endless need for money to pay for mysterious car breakdowns and vet bills for the dog, the many trips to see doctors for a once very healthy and fit young man, the horrible pain he was experiencing when his marriage fell apart. We wondered, of course, but were too far away to verify. We spoke frequently with our son but saw him briefly only three times over the past three years. Meanwhile, his addiction truly began to escalate.

It does no good to wallow in self-pity. It is just as futile to assign blame and fault. Pain, hurt, anger, frustration, desperation, sorrow, fear — all of these, and so much more, are ongoing and understandable. However, the one thing this disease cannot take from us is hope. The rational side of my being knows about evidence-based treatments, what has the best outcomes for success and what needs to happen.

In that sense, it has made things much easier for our family to endure because all of what is unraveling is in the range of “normal,” and that brings great solace. Our family is attending family counseling, going to Al-Anon meetings, reaching out to trusted friends and relatives, and realizing that we are so incredibly not alone. Still, it amazes me that if we were to tell a friend that our son has cancer, heart disease or even HIV, the response would be more understanding, more forgiving, more helpful. We have come light years in the field of addictions during the past two decades (I know — I teach this stuff!), yet we remain in the Stone Age as far as acceptance, understanding, scorn, victimization, blame and judgment go.

My hope is that readers will find some comfort in this writing (counselors are human beings first, with real-life crises of their own). I have found that addiction is an immensely alienating and isolating disease. So many people believe it will not happen to them or their loved ones because, after all, the person does decide on their own to pick up that first drink or drug, right? However, no one ever sets out in life to become an addict of any kind.

As human beings, our physiological needs are the most basic and supersede all others (refer to Abraham Maslow’s hierarchy of needs). We want relief from our physical/psychological/spiritual pain now and resort to self-medicating on a regular basis. I often ask my students, “What is your drug of choice? Is it caffeine, tobacco products, shopping, gambling, exercise, relationships, etc., etc., etc.?”

The point is, we are all slaves to our prefrontal cortexes, and once we find something that works for us, we make those lovely endorphins, the “intermittent positive reward” phenomenon takes hold, and we get positively rewarded for repeating that behavior. We are masters at conning ourselves into believing that the consequences of whatever we rely on continue to be far less than the rewards. And slowly, insidiously, the disease of addiction takes on a life of its own for far too many.

 

A time to take action

We know the physiology behind addiction. Those of us in the field screamed our warnings regarding OxyContin when it was first introduced in the late nineties. It didn’t require a huge knowledge of biochemistry to recognize the effects; its victims were immediately seen and affected so devastatingly.

Addiction professionals continue to scream from the highest pinnacles about the high potentiation for addiction from these drugs; we portended this epidemic well over a decade ago. And yet, here we are, still screaming of the dangers even as countless individuals are prescribed these drugs daily.

In 2017, the Centers for Disease Control and Prevention estimated that more than 115 people die every day due to opioid overdoses. I am not blaming the pharmaceutical companies (though perhaps I should?) or the physicians. Their ultimate goal (one hopes) is to adhere to the Hippocratic oath, to do no harm and to relieve human suffering. However, I believe that we have reached a tipping point, as Malcom Gladwell described in his book of the same name. Our nation is realizing that this crisis affects our mothers, our fathers, our sisters, our brothers, our daughters, our sons, our relatives, our friends, our co-workers, our ministers, our doctors … and ourselves.

The #MeToo movement has shown us the time for action is now. The #TimesUp movement is doing the same. The #NeverAgain movement is gaining immense momentum. It is time for our passions, our sensibilities and our combined courage to demand more research and increased access to treatment. It is time to get over our fear, ignorance and blame regarding addiction. And we need, once and for all, to acknowledge that the disease of addiction is happening at lightning speed all around us, with no letup in sight.

There is no time to waste on blame or recriminations; we need to act. Addiction can take hold of any of us, regardless of our training, our background, our socioeconomic status or our rationale. It happened to my son, despite all of the knowledge I possess as a counselor.

My fervent belief is that with understanding and proper intervention and treatment, we can more readily help those who are afflicted. More importantly, I believe we need to get at the real root of why people need to self-medicate in such powerful ways. We knew our son had problems with depression. He attended a few counseling sessions over the years, but there was no incentive to stay, and even taking the step of seeing a counselor came with perceived stigma. We all have the power to change the paradigms around this.

As of this writing, our son is more than 60 days clean and counting. He has completed his residential treatment and is living with us, taking it one day at a time and trying to deal with life on life’s terms. The neglect of his overall health has taken a huge toll, but together, we are trying to slowly repair its ill effects. This will definitely take time, but the joy is that now we do have that precious commodity.

My message to all my dear counselor colleagues is this: This disease affects all of us. The palpable pain of our nation is excruciating, and we are all awash in its collective anguish. As a nation, we must reach out, not suffer alone. We need to find hope, discover solace and all begin to heal. We also must find the profound courage to act and change our national discourse and paradigms on how we view and treat people who are self-medicating in hopes of finding relief from traumatic pain.

As counselor change agents, we can do this! There can be no higher calling. #EndOpiods.

 

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Antoinette D’Angelo is the pseudonym for an assistant professor of counselor education teaching in a university in the western U.S. She is a licensed mental health counselor, national certified counselor, master addiction counselor and licensed addiction counselor. She has worked in the human services/counseling profession for over 44 years. Her research interests include substance abuse and trauma treatment; crisis and disaster counseling; counselor wellness and alternative holistic treatment methods; and immigration, DACA, and refugee assimilation and reform.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Behind closed doors

By Zachary David Bloom May 7, 2018

Few topics are more controversial or downright uncomfortable to talk about than sex and sexuality. It seems we could examine any period of time in human history and find a number of social values and ideas related to sexual behavior, all of which might be discussed with some nuanced language or slang of the time. More often than not, we would find some positive messages about sex but also a fair share of messages that promote — intentionally or not — feelings of guilt and shame. Even with the timeless double binds that accompany messages around sex and sexuality, it is important to recognize that sex remains an important part of our storied history. After all, without sex, we wouldn’t even be here to have this conversation.

When we talk about sex, we are talking about something loaded with assumptions and values. Sex does not exist in a vacuum; rather, it is woven into our personal identities. It is with that idea that I want to encourage sensitivity and tolerance for a topic that has been dressed up and dressed down: pornography.

Sex and pornography in the 21st century

When considering key markers of sex and sexuality that exemplify the zeitgeist of today’s technological era, one might think of pornography, an industry that pulls in billions of dollars each year. Access to pornography has only increased with widespread use of the internet and the diverse number of gadgets available to connect to it. As such, it makes sense that counselors report working with more and more clients who have issues related to their pornography use.

Researchers have attempted to establish correlations between pornography use and a number of other issues of clinical concern (e.g., depression, anxiety), but it has been difficult to draw any definitive conclusions. However, we do know that clients are presenting to counseling for issues in their romantic relationships related to pornography use (e.g., fighting about how much or how often it should be viewed, if at all), for issues that mirror symptoms of addiction related to their pornography use and for a variety of other issues that can be traced back to their pornography use.

Some of the more nuanced issues related to pornography use include clients reporting decreased sexual satisfaction in their primary relationship or even an inability to perform sexually because of a desensitization to sexual stimuli. Some clients report experiencing anxiety and distress about expectations — either self-imposed or solicited by a partner — to replicate acts depicted in pornography that contrast with the client’s value system. Similarly, some clients report experiencing distress connected to feelings of inadequacy that result from comparing themselves with the actors and actresses in the pornography industry.

This is not an exhaustive list, but I believe it speaks to what has been identified in the counseling literature and what counselors have anecdotally reported seeing in their practices, which parallels what I have seen in my own clinical practice. It is also worth noting that clients are more likely to come to counseling with presenting issues that appear not to connect to their pornography use. Most often, this is because the presenting issue simply has no connection to their pornography use. Other times, it is because clients have not yet gained awareness of how their presenting issue relates to their pornography use or, commonly, do not yet feel safe enough in the therapeutic relationship to talk about their pornography use. Yet the question remains: Why are clients now coming to counseling for issues related to pornography?

Accessing pornography

Imagine a child on a school playground in Anywhere, America, playing with their friends when they hear a sexual word or phrase that they’ve never heard before. Maybe they don’t even know that the word has anything to do with sex or sexuality. Now imagine that the child is too embarrassed to ask their friends about it, so the child either types the word into an internet browser on their smartphone or waits until they get home to Google it. In a matter of seconds, the child is confronted with definitions that might go beyond their scope of understanding or is seeing a sexual act, either via high-definition images or video.

Although this example doesn’t fit as well for older age groups, it is representative of how the cultural narrative around pornography has changed from previous decades. You can imagine that the same child in the 1970s or 1980s would not have had easy access to that kind of content. Instead, the child would have needed to ask a friend or relative to explain the concept or term. Even if this person felt uncomfortable with the question or was not the ideal person to ask, there still would have been a connection between the two people. In other words, the child would not have been left to wrestle with this concept in isolation.

In previous decades, if minors wanted to access pornography, they had to find it, borrow it or steal it. Adults needed to show an ID to purchase it. Today, the only thing required to access pornography is a technological device. Even devices with software blocking services work inconsistently at best. Consequently, we are simultaneously more connected and more isolated than we have ever been in human history.

When we think about the dynamic and contrasting messages that society promotes about sex and sexuality and place that in conjunction with sexuality being tied into a person’s identity and valuation of themselves and others, it makes sense that we are seeing an increase in problems related to client pornography use.

Discomfort with sexuality

One could make the argument that most clinical issues might increase or decrease along with the availability of and accessibility to: fill in the blank. For example, a couple might argue more when they reach retirement and spend more time together (i.e., an increase of minutes together). The issue of pornography, however, is more dynamic than its presence or absence because it is a piece of the larger puzzle of sexuality. As readers are likely aware, there is often a significant amount of shame and guilt tied to issues of sexuality — for clients and counselors alike.

Sexuality is described as being part of the human experience, and the helping professions’ various accrediting bodies recognize it as such. However, human sexuality is not a standard and mandated part of counselors’ training. In fact, the general sex education that a counselor receives as a child and adolescent in elementary, middle and high school varies in depth and breadth — if it’s covered at all. Consequently, counselors experience a wide spectrum of comfort levels when it comes to discussing issues of sexuality in general. In addition, counselors’ comfort with sexuality influences their propensity to assess and treat clients for sexual issues.

Perhaps because of their lack of formal or meaningful sex education, some people — including counselors — have reported turning to pornography to learn about sexuality. The concern about this is that pornography is not considered to be a realistic portrayal of sex or intimate relationships. Thus, it might lead individuals to form unrealistic expectations about what happens in a sexual encounter and to pursue sexual activities that could interfere with fostering a successful or satisfying sexual experience. At the same time, counselors might be impaired to provide helpful or accurate psychoeducation to their clients related to sexuality if they do not have a more reliable source of information than pornography.

Taking down barriers

The best way to position yourself to meet your clients’ needs when it comes to working with issues of sexuality or pornography is to know yourself. These are controversial topics, and the first step in being available to your clients is to take ownership of your own beliefs, values and attitudes about sex, sexuality and sexual behaviors. As a starting point, ask yourself how comfortable you feel when thinking about working with a client who reports wanting to reduce their pornography use or who says their pornography use is interfering with their romantic relationship. If you notice discomfort or an aversion to working with a client on those issues, it might be a good time to seek consultation or supervision concerning the source of your discomfort.

In my experience with counselors-in-training and counselors I have met at various conferences, the discomfort tends to stem from one of three things:

1) Religious or spiritual values that make it difficult to maintain a stance of unconditional positive regard

2) Previous experiences of trauma that make it difficult to stay present when delving into discussions of sexuality

3) Feelings of incompetence when it comes to forming or maintaining healthy sexual relationships

For issues of personal values and beliefs — whether stemming from religious/spiritual foundations or not — I think it can be beneficial to pursue counseling services to explore those feelings of discomfort. Counseling can be an effective way to question and deconstruct beliefs that might be interfering with the formation or maintenance of a therapeutic relationship with a client who is wrestling with any of these issues. I find it helpful to allow myself to maintain my belief system and simultaneously place brackets on that belief system so that I can join a client or couple without my lens impeding on their experience. Sometimes I find that working with a client or a couple might remind me of an old belief or value that I once held. I can recognize that the belief is no longer serving me and that I am ready to discard it.

As this discussion relates to previous experiences of trauma, we understand that healing is an ongoing process. Sometimes we might believe that we are healed until we are confronted by our own limitations. We then recognize that it is time to delve further into healing from the past so that we can stay in the present. This, of course, extends beyond issues related to sexuality; it applies anywhere in the counseling relationship in which we find ourselves bumping up against our own walls.

As it concerns feelings of incompetence, counselors’ training in treating issues of human sexuality and their general exposure to sex education vary. I suggest that counselors ask themselves three things: What do I know? What do I want to know? Do I feel confident to relay this information?

To address any deficit in knowledge or any identified room to grow or learn more, I recommend that counselors prepare themselves to work with clients by finding educational resources on sex and sexuality. I also encourage counselors to pursue additional training or workshops through their professional memberships and state and regional conferences. Through identifying our areas of discomfort and our learning curve for the future, we prepare ourselves to best meet the needs of our clients. Of course, we need to be aware throughout the entire process of what our limitations are and when it is time to refer out to another helping professional and possibly even to a certified sex therapist.

In addition to preparing ourselves for working with clients through their sexual issues or regarding their pornography use, we need to provide a space for clients to address these issues. Counselors who report working with clients for issues related to their sexuality or pornography use also often report that they did not ask their clients about these issues. I believe that by soliciting that information early in the counseling relationship — through an intake questionnaire or intake interview — we implicitly state to our clients, “I am willing to discuss this issue, and this is something you can talk about here.” Again, because of the amount of guilt and shame our clients can feel around issues of sexuality, it becomes that much more important to ensure that we are maintaining a safe, supportive and confidential professional relationship.

In my clinical practice, my intake questionnaire includes a space for clients to report on areas in which they have concerns (or in which a family member or friend has raised concerns about them). These areas include gaming, eating, gambling, shopping, sexual activity and pornography use. Only rarely do clients circle “yes” to sexual activity or pornography use. More fruitfully, however, when reviewing the intake packet with clients in session, I ask, “Would this be a place where you might feel comfortable enough to talk about any issues related to sexual activity or pornography use if it came up?” Even if clients state that they do not have a problem in those areas, by having that conversation early on, the implicit message I send is that they can address any concerns related to sexuality or pornography should they ever want or need to.

The work

Beyond knowing ourselves and our own limitations — including when to seek counseling ourselves and when to refer out — there are a handful of recommendations for working with clients regarding sexual issues or pornography use. First, it is necessary to co-create a working definition with the client regarding the presenting issue and any important terms being discussed. In the case of pornography, I recommend asking clients how they define what pornography is. Across the counseling literature, definitions of pornography vary, but what is most important is that you and your client are speaking the same language. So, from the client’s perspective, does something qualify as pornography only if explicit sexual acts are involved, or is it anything that includes nudity? Does sexually provocative material count, even if it does not include nudity?

It is necessary to create this shared definition so that you don’t accidentally dismiss a client’s use of “pornography” as not warranting attention when it is something that is causing the client distress. For example, if a client experiences feelings of guilt for viewing images of clothed people in sexually provocative positions, we want to validate the client’s experience of guilt, even if it might not intuitively resonate with the way that we personally define pornography.

In the same vein, we want to ensure we have a shared definition so that we do not miss opportunities to assist our clients in meeting their clinical goals. For example, I once worked with a man who wished to abstain from pornography use and masturbation for religious and spiritual reasons, and he seemed to be making progress. However, I came to realize that although he was abstaining from traditional pornography use and masturbation, he had begun to engage in more frequent promiscuous sexual behavior. After finding out more about his promiscuous behavior, we were better able to define the “spirit” of his counseling goal, which was to gain greater control over his sexual activity — including abstaining from anonymous sex.

Both in co-creating definitions of pornography with our clients and in the clinical work we do with them, it is also necessary that we model appropriate language. There are compelling reasons to believe that pornography use might promote sexist or harmful beliefs about women resulting from how they are portrayed in pornography. As social justice advocates, it is our job as counselors to balance the deconstruction of sexist or misogynistic ideas without alienating our clients by using overly clinical language or shaming them.

In practice, this means finding a way to ask clients to clarify what they mean when they use a certain term. Similarly, when we use a sexual term, we want to make sure we are using language that the client understands that is also as free of negative associations as possible. In my experience working with clients, depending on the length and strength of our therapeutic relationship, I will typically begin by using the client’s language — asking for clarification when I hear a new term with which I am unfamiliar — and gradually introducing more neutral language to replace the previously value-laden language. As I do this, sometimes the client will follow my lead and it becomes a trend that continues until we are using more value-neutral language throughout all of our sessions.

Other times, I might find a way to introduce a moment of psychoeducation in which I clarify my change in language with the client. I then ask the client to try changing their language too as an experiment to see if they notice any differences in the way they are thinking or feeling. Usually, I can find a way to do this that supports the presenting clinical concern. For example, with a client who presents for counseling for symptoms of depression resulting from the termination of a romantic relationship, I might be able to make a connection between “power” in a relationship and the importance of “respect” in a relationship. We can then discuss how altering our language is a concrete step we can take toward facilitating the change of finding more respect and more even distributions of power in a relationship.

Beyond taking general steps to prepare yourself for working with issues related to sexuality and pornography use, it is also important to be able to provide specific psychoeducation to clients regarding their presenting issue. This is not something that is achieved and completed but rather an ongoing component of being a counselor. Sexuality is diverse, and we need to have sound sources of information not only for ourselves but also for our clients.

Typically, I find in my work that a client’s presenting issue includes myths or deficits in knowledge about sex and sexuality. With younger clients, I find that the deficit in knowledge is often related to safe sex practices. Therefore, I recommend familiarizing yourself with books that you can feel comfortable promoting and sharing with your clients, and internet videos or links that are not pornographic in nature that can serve as educational resources.

Individuals and couples I have seen in counseling for issues related to sexuality or pornography use tend to have one thing in common: They want to have a fulfilling sex life. Consistent with findings in the counseling literature, I emphasize to my clients that a fulfilling sex life comes from a sexual relationship that is founded on trust and vulnerability. In line with that, for some individuals and for some couples, pornography use can be a barrier toward open, honest and vulnerable sexual expression, especially when their sexuality is framed by messages of expectation. Instead, I promote mindfulness practices, sensate focus activities and building on previous experiences of success. Overall, I find that clients make the most progress when they understand that the sexual fulfillment they are seeking is with their actual partner and not with an imagined conceptualization of their partner or a different and more ideal partner.

As part of counselors’ work of addressing issues of sexuality and pornography use, we need to be prepared for clients to ask us about our own sexual experiences and whether we use pornography. I don’t know how often clients actually raise questions along those lines, but I think that we need to be prepared for such instances. As with most topics, I encourage counselors to explore their own levels of comfort with disclosure and to assess whether their disclosure is for their clients or for themselves. Some disclosures are more or less appropriate with certain clients but not others. However, the entire topic of disclosure becomes especially complicated and potentially harmful when discussing sexuality and pornography. Because of the sensitive nature of the topic, I would encourage you to err on the side of caution when making any disclosures with clients about your own experiences, and I would also encourage you to be prepared with a statement so that you are not caught off guard by a client’s questions.

In the classroom, in session and at various counseling conferences, I have been asked about my personal stance on pornography use. The response that resonates most for me is to remind my clients that what might be right or wrong for me might not be right or wrong for them. In addition, I would not want to influence their choice or decision beyond assisting them in identifying their beliefs about sexuality and helping them to live congruently within their value system.

 

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Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

Zachary David Bloom is an assistant professor at Northeastern Illinois University. He is also a licensed clinical professional counselor and a licensed marriage and family therapist. He specializes in working with couples and with individual clients with trauma. His research interests include the influence of technology on romantic relationships. Contact him at zacharydbloom@gmail.com.

Letters to the editorct@counseling.org

 

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Related reading, from the Counseling Today archives: “Entering the danger zone

The absence of formal and accurate sexual education is a particularly American problem that may find its way into the offices of professional counselors. wp.me/p2BxKN-3JE

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Grief, loss and substance use

By Susan Furr and Derrick Johnson December 5, 2017

Andrew’s mother was so happy that he had finally agreed to enter treatment for his drinking problem. He had been an excellent college student until his hard partying began to take over his nights, leading to missed classes and incomplete assignments. He still managed to get a decent job that involved a lot of travel and client dinners. Andrew’s mom thought these responsibilities would help him settle down. What she didn’t realize was that he would begin using stimulants to keep up the hectic pace. When combined with his socially sanctioned business drinking, Andrew’s performance soon suffered.

Andrew managed to cover up the cracks in his professional veneer for several years before finally passing out one evening from a combination of exhaustion and alcohol. Thankfully, his company supported his entry into treatment, a move that encouraged his mother.

During one of the family visiting days, Andrew’s mother was thoroughly confused by his anger over giving up his substance. He had believed that treatment would help him “dry out” and then return to his previous life. “I don’t know why they expect me to give up people, places and things associated with my drinking,” Andrew lamented.

Andrew’s mother wanted to scream that this was such a small price to pay for Andrew to regain his life before it was too late. What she didn’t realize was that she had just encountered the first glimpse of Andrew’s grief related to recovery. Many other layers of grief would need to be uncovered and processed in the weeks and months ahead.

Confronting losses

You do not have to be an addictions counselor to encounter the grief related to substance use. I (Susan) worked for many years in a college counseling center and encountered students struggling with losses related to family members who were addicted. Substance use had taken away the parent they longed for.

For other students, siblings who were addicted created a range of issues, from trying to engage the student in substance use to wanting the student to “cover” for them. In the extreme, counselors may connect with students whose sibling overdosed while they were away at college, adding to their guilt because of a false belief that they could have prevented the act.

Given that college students are engaging in their own developmental issues around identity, they may be in a place to face these issues for the first time. Many college students begin to recognize some of the harmful effects created by the environments in which they lived.

Perhaps the most difficult case I encountered was a young woman who was beginning to address childhood sexual abuse perpetrated by her father. During our work together, her father contacted her to apologize for any harm he might have done, although he professed that his memories were cloudy because of his substance use. He was now in recovery and trying to make amends. Although his confession reaffirmed my client’s own memories, she was left grieving for the father she never had.

Groups such as Adult Children of Alcoholics evolved to support those whose lives have been upended by the addiction of someone else. In examining your client’s history, gathering information on any substance use issues in the family may go a long way toward helping the client understand the evolution of his or her current emotional challenges.

The loss of identity

Grief is often a forgotten aspect of recovery. Out of necessity, the need exists to focus on the physical aspects of addiction to alcohol and other drugs (AOD). These physical aspects of addiction are much more challenging than acknowledged by a “just say no” culture. Think about giving up that first cup of coffee each morning — for the rest of your life. And then multiply that impact manyfold.

Treatment programs have developed protocols to help clients navigate this process on a physical level, and support groups such as Alcoholics Anonymous (AA), Narcotics Anonymous and SMART Recovery help deal with the abstinence aspect of recovery. However, the idea of grieving the loss of one’s substance may seem contradictory to treatment. After all, giving up a destructive substance is a good thing — right? Regardless, any change, no matter how positive, often creates a sense of loss.

One way to think about this issue is to focus on the identity the client forms with the addictive substance rather than just thinking about giving up the substance. Clients often develop a positive view of self in terms of their substance, such as being able to “hold one’s liquor” or a female being able to “drink like a guy.” They gain a positive status for their drinking or drugging prowess; in other words, the user gains a sense of belonging and significance.

As substance use becomes a core value, social networks form around the experience of “using.” For example, one’s knowledge base and interest revolve around being aware of the best microbreweries or having a refined wine palette or even knowing the best place to buy meth. Identity begins to form around using and being with other users. The use of mobile apps that help “connoisseurs” identify and cross off “must-have” finds further increases the social lure of drinking and using substances. These items combine to develop an identity for the user and the onset of a relationship between the substance and the user.

More profound is the discovery of the purpose of substance use. Does it relieve anxiety in social situations or loosen inhibitions with potential relationship partners? How does the substance help the client cope with painful emotions caused by other losses? It is not uncommon for people to cope with a painful situation by going out for a drink, but for some, the substance becomes the go-to solution for any life stressor. I recall a bar that gave out a free drink for every job rejection letter that one of its patrons received. On the surface, this was a way to lighten the mood, but on a deeper level, it was just another way of teaching poor coping strategies — in this instance, managing loss through the use of substances.

Social networks can revolve around a culture of using. Stopping by the neighborhood bar after work may evolve into hanging out with the guys until closing time — dinner missed and a partner outraged. After awhile, users seem to prefer the company of fellow users over that of the distraught family. These gathering places often become part of a ritual, providing a structure that may normalize the damaging behavior. Recall the old TV show Cheers, “where everybody knows your name.” The act of walking in, seeing familiar faces and sharing a favorite drink creates a comforting routine that overshadows the underlying harm caused by abusing substances.

The grief aspects of recovery

To be successful in recovery, the client has to let go of all of the comforting aspects of using. These things must be grieved in order for the client to move forward.

Entering treatment means leaving behind the familiar and facing the unknown. On a cognitive level, giving up immediate gratification for future gains may make sense, but the actual experience of change also results in losses that need to be acknowledged.

Clinicians who understand the role that loss plays in recovery have devised activities, such as writing a goodbye letter to one’s substance, which recognize that even the loss of something that is ultimately negative needs to be grieved. It was through my work in grief and loss counseling that I first became aware of the loss associated with giving up one’s substance. Kathryn Hunsucker, a graduate student at the time, began applying the concept of loss to recovery and found that this concept resonated with her clients. We began working together to use some of the existing grief theories to conceptualize recovery in a way that made sense to clients. Derrick Johnson, an addictions counselor in Charlotte, North Carolina, has teamed with us to extend this approach to families. The theories of both J. William Worden and Therese Rando have been instrumental in helping us conceptualize the grief aspects of recovery.

Grief and loss show up in other phases of recovery too. Clients not only grieve giving up their substance and fellow users, but they also begin to examine losses throughout their lives. Once clients are engaged in ways of maintaining their abstinence and perhaps working through the steps of AA, they begin facing the choices that they made while using. In this phase of recovery, clients may begin to recognize that the consequences of their choices often involved a loss.

The underlying loss may be about the loss of the person the client once was or aspired to be. Some clients lament the loss of meaning in their life and their disconnection from spiritual or existential values. Often, however, there are more concrete losses that may include jobs, family, freedom and home. It is common to see the recognition of these losses emerge as clients address steps No. 8 and No. 9 of the Twelve Steps. Acknowledging those who have been harmed and making amends forces clients to see how they might have created their own losses.

The realization that this time can never be recaptured may trigger new waves of grief that can dampen the sense of hope that treatment initially fosters. Creating space for grieving is necessary to help cushion against relapse. This space is created by the counselor’s willingness to address the issue of loss directly. Clients often are surprised when the counselor asks them about the grief they experience in giving up their substance, but they are typically quite open to sharing what they will miss about using. If we pretend that no sense of loss exists, our clients will continue to avoid facing the losses that they will encounter in recovery.

Throughout the recovery process, clients often fight against memories of painful and traumatic experiences that may initially have contributed to their substance use. Counselors may be drawn to pursuing issues such as childhood sexual abuse early in treatment because the core nature of these events is linked to their clients’ emotional pain. However, until skills to maintain abstinence are developed and more recent losses have been grieved, it may be more productive to focus on the skills needed to contain these feelings. Kathryn Hunsucker, who is now an addictions specialist in Morehead City, North Carolina, suggests “bookmarking” these issues and returning to them at a later date — ideally when clients have formed the strength to encounter the pain associated with these losses.

Metaphors and other creative approaches

Derrick Johnson saw his practice change after adding grief counseling as part of his approach in treating addiction. Of specific interest is his use of “love” as a metaphor.

Derrick has clients think of a romantic love or someone very special to them whom they lost due to the person’s death. Derrick then asks his clients to list both the positive and negative aspects of their relationship with this person. After examining these relational attributes, Derrick next asks, “Did you stop loving that person the moment you said goodbye?” Of course, the reply is “no.” The use of this metaphor creates understanding and generates recognizable feelings and thus becomes a cognitive tool for clients to make the connection to their experience of giving up a substance.

Another example could be the termination of an intimate relationship. Again, although saying goodbye leads to a newly defined relationship status, it does not mean that love immediately stops. Through group discussion, members are able to understand that just because they love someone does not automatically qualify it as a healthy relationship. Similarly, love of or use of a substance does not equal compatibility. This parallels AOD abuse/dependence, which is not compatible with successful life engagements and life fulfillment. Through this metaphor, clients are able to draw parallels between giving up a substance and the loss of a relationship.

Acknowledging that it is OK to grieve the loss of the substance is essential to helping clients move through that initial fear of giving up or losing something. It is no different than acknowledging the passing of a loved one or the end of a relationship. Would counselors take that away from a client who is mourning? Of course not.

Engaging in creative approaches to help clients visualize their losses can also be valuable. Kathryn often uses an activity that starts with a handout, “What Baggage Do You Carry,” illustrated with different types of suitcases. She asks clients to fill the bags with the losses they carry around with them because of their addictions. Clients then explore what it would mean to take items out of their bags to lessen their loads. Emotions related to giving up the items are then examined. This is one concrete way for clients to increase awareness of the losses they may need to grieve.

Another awareness activity Kathryn uses is “Life Event Bingo.” In this activity, group members are given bingo cards featuring different life events in each square. Group members are instructed to mingle to try to find someone who has experienced a particular life event in the past year and to learn what coping techniques worked best for the person in that situation. Group members then record the person’s name and coping strategy in the appropriate box. The goal is to find a different person for each box so that group members make connections with others and explore different ways to deal with life challenges.

It is important to allow clients to discuss and make a list of those things that they miss about using. Though contrary to intuitive treatment protocol, it is important to remember that people use substances to alter their feelings, which means that the complete spectrum of feelings must be explored. This process involves careful one-on-one work between the client and therapist that can uncover a multitude of clues about why a client uses substances.

For example, when Derrick worked at a 90-day intensive outpatient facility, the identification of engagement and belonging was a key factor in uncovering the etiology of one client’s substance dependence. Specifically, this binge drinker identified fall and winter as “just my perfect time.” Upon closer examination, Derrick discovered that attending NFL football games and tailgating prior to the games provided this client with a keen sense of belonging. Thus, giving up drinking also meant saying goodbye to his ritual and way of belonging. This client had to grieve the loss of his ritual and what the loss represented as it related to his identity.

Closing thoughts

Grief and loss issues are essential to explore when working with people living with addictions but, frequently, this focus is left out because of the many competing issues that arise. Although those who are in treatment gain a new understanding of what it means to grieve the loss of their substance of choice, this process may be confusing to those in their support networks. The family just wants the person back whom they lost to addiction. We need to be sensitive to the losses faced by families who have their own grief to explore. They, too, have lost hopes and dreams that were shattered by addiction. Even with effective treatment, the person who returns to them has been changed by the addiction experience and will need to continue to work on personal abstinence.

Families may need additional support as they work to reintegrate their family member returning from treatment. Groups such as Al-Anon can provide needed encouragement and understanding. But as is the case with all losses, grief must be faced and experienced as part of the healing process. Often, the lessons learned from the loss can lead to an enriched way of living, both for the family and the person in recovery.

 

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Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

Susan Furr is a professor in the Department of Counseling at the University of North Carolina at Charlotte (UNC Charlotte). She had 16 years’ experience working at the university’s counseling center before moving to teaching. Her interests include grief and loss counseling, crisis intervention and counselor development. She is an active member of the International Association of Addictions and Offender Counselors (a division of the American Counseling Association), where she is the editor of IAAOC News. Contact her at SusanFurr@uncc.edu.

Derrick Johnson is a doctoral student at UNC Charlotte with research interest in the association of grief, loss and addiction. He is senior clinical addiction therapist at Legacy Freedom Treatment Center and also has a private practice in Charlotte.

 

 

 

 

 

Letters to the editor: ct@counseling.org

 

 

 

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

Giving children a voice in addiction recovery

By Bethany Bray December 4, 2017

When treating clients struggling with substance abuse, Lindsey Chadwick would like her fellow counselors to keep in mind the toll that addiction takes on children. Addiction affects the whole household. Children feel the effects differently — but as acutely — as adults, says Chadwick, a licensed professional counselor and manager of the children’s program at the Betty Ford Center, part of the Hazelden Betty Ford Foundation, just outside of Denver, Colorado.

“Simply being aware [of the fact] that kids are affected by addiction is a huge piece of the advocacy work that we do,” says Chadwick, a member of the American Counseling Association. “Even if a counselor is working [in addictions] with adults, be thinking of the kids. They are a big part of their grown-ups’ recovery. They matter. Take into account what the kids have to say.”

Chadwick and her colleagues run a program for children, ages 7 to 12, who come from addicted homes. The child’s “grown-up,” a parent, relative or caregiver, receives treatment simultaneously through the Betty Ford Center’s programming for adults. The children come for an intensive, four-day workshop that focuses on coping skills and education on what addiction is, and – most importantly – that it’s not their fault, says Chadwick.

“Most of all, we try and help them have fun and be a kid. They are often caught up in very grown-up situations at home,” says Chadwick.

Children from homes where  addiction is present often  take on roles they’re too young to play, such as caring for younger siblings or being a peacemaker or mediator in the home, she

Lindsey Chadwick at work in the children’s program at the Betty Ford Center just outside of Denver, Colorado.

explains. At Betty Ford, Chadwick and her colleagues do a lot of role-play, sharing activities and psychoeducational games with the children, as well as non-therapeutic games, snacks and swimming at a nearby pool.

“For the most part, on the surface, our kids look like any other kids,” says Chadwick. “But we see a lot who are struggling with anger toward their grown-up or family members. We see a lot of very anxious and nervous kids who have taken on a lot of adult roles because they needed to.  Some of our kids have also experienced abuse and neglect. Addiction is an equal-opportunity disease, so we see it in all kinds of families.”

Children who come through the program often struggle with perfectionism, an extreme focus on maintaining control and “not making waves,” says Chadwick. Also, children who come from addicted homes often experience loneliness and guilt or feel like their family is not as good as others.

Many children feel like the addiction is somehow their fault – a message they focus on reversing, says Chadwick.

“We teach them that many people go through what they’re going through,” she says. “We want them to really learn their strengths. Despite the addiction, it doesn’t mean that they can’t love their family, or that other things [in their life] aren’t going well.”

In households with addiction, feelings and problems are not usually talked about or addressed. This unwritten “rule” of not talking about struggles or emotions is passed from older to younger generations, Chadwick says. At Betty Ford, they work to undo those patterns, teaching children to express what they’re feeling – with an aim to keep them from falling into addiction when older.

“A lot of our kids don’t have the language [to express the struggles of addiction]. We try to give them the language to talk about what’s going on, to identify what’s wrong and tell someone,” says Chadwick. “… We give them the space to know that they matter, and it’s OK to let things out.”

In addition to talking to express themselves, they teach the youngsters nonverbal ways to let out their emotions, such as drawing, physical activity and other self-care activities. They also identify who is safe to talk to (i.e., a counselor, trusted adult or peer) and when. “Addiction sometimes confuses that for them,” explains Chadwick.

“We have kids who come in, and they’re angry, sad or mad, and they don’t want to be here,” she says. “On the last day [of the program], they’re happy and smiling – they’re a kid again. It’s such a wonderful transformation to be a part of.”

Psychoeducation activities at the Betty Ford children’s program also involve a cartoon character named Beamer. He stars in a series of books that the Betty Ford Center uses in their children’s program.

Both of Beamer’s parents struggle with addiction, and one is in recovery, and the other is not, explains Chadwick. Beamer navigates the ups and downs of living in a household coping with addiction in each of the books.

“Kids really love Beamer because they’ve never really seen a character that’s going through the same things as they are,” Chadwick says. “It’s very validating to learn that they’re not alone. They relate to him. A lot of the situations he’s been in, they’ve been in – his struggles at school and interactions with family. It gives them a vehicle to talk about it as well, and helps them feel more comfortable.”

Betty Ford counselors sometimes encourage the children to write Beamer letters as a therapeutic tool, adds Chadwick.

All families who go through recovery programs at the Betty Ford Center are referred for therapy in their local area. They are also invited back for weekly follow-up programming and support groups.

Chadwick has worked for nine years at the children’s program at the Betty Ford Center. In addition to Chadwick’s program in Colorado, Betty Ford also offers children’s programming at centers in Dallas and Rancho Mirage, California.

“I grew up in a family where addiction was a problem for multiple generations. I saw things that I shouldn’t have as a kid. I’m happy to give back to these families,” says Chadwick. “It’s so amazing, as a therapist, you get to work with the kids on their level and have so much fun throughout the day, but also help focus on recovery … It’s really amazing to watch these families heal. The adults in the [Betty Ford Center] program really want what’s best for their families, and it’s wonderful to be part of that process.”

 

 

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Find out more about the Hazelden Betty Ford Foundation’s children’s program at hazeldenbettyford.org/treatment/family-children/childrens-program

More information on the “Beamer” character and materials can be found at mybeamersworld.com

 

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Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org

 

Follow Counseling Today on Twitter @ACA_CTonline and Facebook at facebook.com/CounselingToday.

 

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.